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Paediatric Otorhinolaryngology and COVID-19
1. Introduction Martin Bailey, London, ESPO Secretary General
2. General update about SARS-Cov-2 in childrenAdam Finn, Bristol
3. Consultations: remaining indications and specific precautions Marc Pellicer, Barcelona
4. Precautions regarding medical treatments in paediatric ENTFrançois Simon, Paris
5. Hearing tests: remaining indications Luisa Monteiro, Lisbon
6. Surgery: preop assessment, remaining indications and specific precautionsAri de Rowe, Tel Aviv
7. Recovery Mike Saunders, Bristol
8. Conclusion Vincent Couloigner, Paris
Paediatric Otorhinolaryngology and COVID-19
1. Introduction
Martin Bailey
ESPO Secretary-General
formerly ENT Surgeon
Great Ormond Street Hospital London
Paediatric Otorhinolaryngology and COVID-19
2. General update about SARS-Cov-2 in children:
Adam Finn
Professor of Paediatrics
University of Bristol UK
Bristol Royal Hospital for Children
Paediatric Otorhinolaryngology and COVID-19
3. Consultations : remaining indications and specific precautions, especially regarding flexible naso-endoscopy and laryngoscopy:
Marc Pellicer
ENT Pediatric Consultant
Vall d’Hebron University Hospital
Barcelona, Spain
Paediatric Otorhinolaryngology and COVID-19
4. Precautions regarding medical treatments in pediatric ENT
François Simon
paediatric ENT
Necker - Children's hospital
University of Paris, France
Paediatric Otorhinolaryngology and COVID-19
5. Hearing tests: remaining indications:
Luisa Monteiro
Consultant ENT Surgeon
Head of ENT Department Hospital dos LusíadasLisbon, Portugal
Paediatric Otorhinolaryngology and COVID-19
6. Surgery: preop assessment, remaining indications and specific precautions
Ari de Rowe
Director of Pediatric Otolaryngology
Dana-DwekChildren’s Hospital
Sourasky Medical Center
Tel Aviv
Paediatric Otorhinolaryngology and COVID-19
BAPO surgical prioritisation during the coronavirus pandemic
Priority Airway, head and neck Nose ears
1a emergencyWithin 24 hours
Microlaryngoscopy / tracheostomy#Acute airway obstructionFB removal- Button battery, sharp FBAirway foreign body causing airwayobstruction
FB removal - Buttonbattery
FB removal - Buttonbattery
1b urgent –up to 72 hours
Mastoidectomy/grommet – acute mastoiditis with complications not responding to medical treatment
External drainage of orbital abscess not responding tomedical treatment or showingvisual compromise
Mastoidectomy/grommet – acute mastoiditis with complications not responding to medicaltreatment
2 up to one month
Neck biopsy for suspected malignancyTracheostomy for weaning purposes in PICUwhere all other options for progression have beenexhaustedThyroidectomy for medically uncontrolledThyrotoxicosis
Mastoid exploration -cholesteatoma withcomplications including labyrinthine fistula
3 up to 3 months
Microlaryngoscopy for progressive airway conditions incl. RRP, subglottic stenosisProphylactic thyroidectomy in medium and lower risk MEN2 patients
Examination under anaesthesiaof middle ear - medicallyuncontrolled CSOM
4 over 3 months
Laryngotracheal reconstructionAdenotonsillectomy - OSA and recurrent tonsillitisNeck surgery - benign and congenital neck lesions not causing airway obstruction
GrommetsMyringoplastyMastoidectomy
https://www.espo.eu.com/news/covid-19-information/
Recovery
Mike Saunders
President Elect BAPO
Paediatric ENT Surgeon
Bristol Royal Hospital for Children
United Kingdom
Paediatric Otorhinolaryngology and COVID-19
Considerations
• ENT staff remain at increased risk from Covid-19 and MUST be protected
• Further peaks, second and third waves seem likely over the next few months
• Return to pre-pandemic practice a long way off
Drivers to increase patient flow
• Increasing burden of elective and semi-urgent cases on waiting list
• Financial impact of activity reduction on hospitals and physicians - depending on healthcare system
• Need to train juniors
• Need to maintain skills for existing surgeons
One solution will not suit everyone
Must be based on national and co-ordinated local planning
What can we do?
Outpatients
Increase telephone or video consultation where possible
Ensure clinic space is safe – e.g. separate room for AGPs, separate entrance, exit, reduce waiting areas
Adequate and correct PPE is vital
Outpatients|: 2
•Ensure that staff are properly protected
•PRIORITISE waiting lists
•Limit accompanying persons
•Pre- visit screening?
Surgical activity
• Base on clinical need – essential to prioritise waiting lists
• What operations can we do safely? (adeno-tonsillectomy?)
• Pre-admission screening. When? What? (history, swab, CT chest,)
• Pre-admission isolation. How long?
• Screening and isolation of accompanying person?
Exiting the pandemic (ENT UK)https://www.entuk.org/sites/default/files/Exiting%20the%20pandemic.pdf
Thank you
Conclusion
Vincent Couloigner
Chairman of the ESPO Education & Training Committee
Service d’ORL Pédiatrique
Hôpital Necker Enfants Malades
Paris
Paediatric Otorhinolaryngology and COVID-19
Paediatric Otorhinolaryngology and COVID-19
Thank You
13-16 February 2021
15th Congress of the European Society of Pediatric Otorhinolaryngology
Transfers, Bridges and Frontiers in Pediatric Otorhinolaryngology
Paediatric Otorhinolaryngology and COVID-19
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